Quality
Specialist
Job Description:
The ideal candidate for this role is compassionate, flexible, self-motivated, detail oriented, and a constant learner. As a Quality Specialist, you will be the subject matter expert for HEDIS/Gaps in Care measures. You will ensure maintenance of programs for patients in accordance with prescribed quality standards; conduct data collection, reporting and monitoring for key performance measurement activities recognized by the NCQA.
Responsibilities
:
- Provides expertise in analysis of data related to supporting value-based programs. Skills include accessing internal databases and tables as well as utilizing Excel skills.
- Participates in meetings with vendors for the medical record collection process. Assists Manager with medical record vendor oversight.
- Participates in projects to ensure the strategic directives of the stakeholders are executed and time sensitive deadlines met.
- Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidence, documentation, and changes.
- Monitor, evaluate and report on program status inclusive of scope, schedule, budget and alignment to program and strategic goals.
- Direct corrective action, as needed, to maintain the viability of value-based reimbursement Programs.
- Provide training and education to staff related to the data available, how to access it, and what metrics might be of interest.
Qualifications:
- Bachelor’s Degree in related field and two (2) years’ experience in the health industry. An equivalent combination of education and experience may be substituted to meet this requirement.
- HEDIS/Gaps in Care Experience
- Knowledge of payers and their requirements for each measure
- Knowledge of Patient Centered Medical Homes and Accountable Care Organizations
- The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
Benefits
:
- Tracking key performance indicators
- We offer a competitive compensation and benefits package including:
- Bi-Weekly Competitive Pay
- Opportunities for professional and personal growth
- Excellent Health Insurance through Blue Care Network with a VIP policy to provide you with affordable access to the best care.
- Premium Dental and Vision coverage
- Buy Up Option for Short- and Long-Term Disability, and Life & AD&D Insurance
- 401(k) investment opportunities
- Generous Holiday, Vacation and Personal time
Employee Recognition and Assistance Programs